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Supporting
Parents Parenting Alone
Hello
South
Tipperary Lone Parent Initiative is a non profit
organisation dedicated to supporting
Lone
Parents in
South Tipperary
. In
order to help us improve our services to Lone
Parents,
we
are asking that you give just a few moments to complete
the following questionnaire.
All
information received is confidential.
If you would like us to contact you for any
reason
please
complete the appropriate section at the end.
We are very grateful and sincerely appreciate
your
taking time to help.
Kind
regards
Liz
Moloney
1.
As a Lone
Parent is there a particularly difficult issue that you
are dealing with currently,
would
you like to describe it briefly here.
____________________________________________________________
____________________________________________________________
____________________________________________________________
_____________________________________________________________
2.
Are you interested in further learning and
development? Yes □
No□
3.
Parenting Skills:
0 – 6yrs
Yes □
No□
7 – 12yrs Yes □
No□
3 –18yrs Yes□
No□
4. Health Issues:
Personal Development
Yes□
No□
Stress management
Yes□
No□
Anger Management
Yes□
No□
Family Planning
Yes□
No□
Healthy Eating / Cooking
Yes□ No□
Alcohol / Drug Dependence
Yes□ No□
First aid for Adults / Children
Yes□
No□
S.T.D. s
Yes□
No□
5. Computer Training:
Beginner’s
Yes□ No□ Advanced
Beginners
Yes□ No□
Intermediate
Yes□
No□
Pre
E.C.D.L. Yes□ No□
6.
Legal Issues:
Yes□ No□
Would
you like information on:
Harassment
Yes□
No□
Domestic
Violence
Yes□ No□
Barring
Order
Yes□
No□
Safety Order
Yes□
No□
Protection
Order Yes□
No□
Would
you like information for Separating
or Divorced couples:
Mediation
Yes□
No□
Divorce
Yes□ No□
Legal
Separation
Yes□
No□
Would
you like information for Non-Married
Parents:
Maintenance
& Social Welfare Entitlements
Yes□ No□
Family
Home
Yes□
No□
Access
to children
Yes□ No□
Guardianship/custody
Yes□ No□
Birth
Certificate Yes□
No□
Co
habitation Yes□
No□
Passports
Yes□
No□
Paternity
Testing Yes□
No□
Other, Please specify
7. Further Learning:
Would
you like information on Training in any of the following?
Improve
Reading
/Writing skills
Yes□
No□
Junior Certificate
Yes□
No□
Leaving Certificate.
Yes□
No□
Post Leaving Certificate Course
Yes□
No□
Other (Please specify)
Yes□ No□
8.
Returning to Work:
FÁS C.E. Scheme
Yes□
No□
Looking for work and the financial implications
Yes□ No□
Help getting a job
Yes□ No□
Interview Skills / CV Preparation
Yes□
No□
How might my present benefits be affected ?
Yes□
No□
9.
Counselling:
If counselling were
available to you, would you like to avail of it?
Yes□ No□
If you would like to be
contacted in relation to any of our services please
provide the following details and we will be in touch with
you as soon as possible.
Contact
Details (Optional)
Name
:
_______________________________________________
Address:
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
Phone:
_______________________________________________
Email:
_______________________________________________
Many
thanks, this information will be of great benefit to us as
we plan for the future.
STLPI, Room 1, Clonmel
Community Resource Centre,
Kickham Street
,
Clonmel, Co.
Tipperary
.
Tel:
052 6127429 Email: stlpi@eircom.net
Website: www.stlpi.ie
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